1. Rescue CBT 1 st Quarter 2013

2. Rescue CBT Car Crash Caught on Tape (click to view video)

3. Multi Car MVC Size up should include but are not limited to the: Scope/Magnitude of the incident. Number and size of vehicles affected. Integrity and stability of the affected vehicles. Number of known and potential patients. Access to the scene. Hazards.

4. Multi Car MVC Exposures to traffic. Environmental factors. Available and necessary resources. Declaration of an MCI if applicable –0-10 (Level 1) –11-20 Pt’s (Level 2) –21-30 Pt’s (level 3) –30+ Pt’s (Level 4) All of these consideration and many others can be accomplished by completing an outer and inner circle survey

5. Apparatus Placement Fire Truck verses Semi (click to view)

6. Apparatus Placement As an initial priority, first arriving officer to motor vehicle accident scenes shall assess all four sides of the work zone to determine the degree of risk exposure from oncoming traffic. Based on this assessment, the officer shall include in their Incident Action Plan (IAP), the provisions needed to adequately protect the work zone. These provisions shall be implemented from the onset of the incident and maintained for the duration.

7. Apparatus Placement Place the first arriving apparatus on the traffic side of the incident in a blocking position for the purpose of creating a buffer zone First arriving units may consider completely stopping all traffic flow until adequate resources arrive and are able to establish adequate provisions for traffic control.

8. Apparatus Placement Place all EMS units so that the patient loading area at the rear of the EMS unit is positioned within a protected work zone. Place other agency vehicles (i.e., police, POV responders, utilities, and State DOT) on the traffic side of the work zone

9. Apparatus Placement Place traffic cones or flares at least 200 feet before the work zone. If a detour can be established, consider closing the roadway at a nearby intersection and diverting traffic

10. Freeway Placement On highways, increase the distance for cones and flares to 400 feet. For long term traffic control, turn the scene management over to Washington State Patrol or the DOT highway response units.

11. Safety at an MVC Once priorities have been established and protection is in place, additional vehicles should be placed in a safe location, generally at the exit of the work zone. Ensure that all members have their traffic vests on any time they are in the work zone on or near the roadway. Identify a primary and secondary escape route and communicate these to the members. Consider designating one member to serve as a lookout to warn other members of traffic that may not heed warning devices.

12. Safety at an MVC Never trust traffic. Do not turn your back to traffic when walking along the shoulder. Place apparatus in a manner that provides an adequately safe work zone. Wear visible, reflective clothing.

13. Patient Care Basic Principles: Maintain Spinal alignment To minimize spinal cord injury and paralysis Minimize body twisting To reduce further injuries and reduce fracture movement and pain.

14. Patient Care Work with extrication crews to allow for treatment to be started during the extrication process. A rescuer needs to do a full assessment of the patient before extrication. –Unless rapid extrication is required

15. Auto Extrication Insane Car Accident ( click to view)

16. Anatomy Rocker Panel Upper rail

17. Anatomy Cont. A-Post B-Post C-Post

18. Anatomy Cont. Engine Compartment Passenger Compartment Trunk

19. Anatomy Cont. The nadar pin (door striker) is part of the door latch assembly and are designed to keep doors closed during an accident. They also: Make prying doors difficult. Are not always in the same spot. Come in two main styles: –Latch Style –Pin Style

20. Anatomy Cont. Door Hinges – can be cut or spread apart to detach a door. Remember that: The wiring in doors may be difficult to cut with hydraulic tools. Hinges come in many different styles and materials.

21. Stabilization Stabilization can be broken up into two separate categorizes: Basic And Advanced * Remember when you lift an inch crib or stabilize for that inch *

22. Basic Stabilization Wood Cribbing Manufactured Step Chalks Wedges Apparatus Wheel Chalks Straps Chains/Hook clusters

23. Advanced Stabilization Air Bags Straps Chains/Hook Clusters Struts –Rescue 42’s –Res-Q-Jack’s –Paratech’s

24. Methods There are a variety of methods used for extrication with the two most popular being: Hand tools AND Power tools

25. Hand Tools Include but are not limited to: Come-along's High-Lift Jacks Glass Masters Wedges Cable cutter Pry Bars

26. Power Tools Include but are not limited to: Cutters Spreaders Rams Saws Air Chisels Torches Saw Zalls

27. Techniques Rapid door pop Total roof removal Roof Flap B post blow out (maxi door) Dash roll Dash jack/lift 3 rd door conversion Misc.

28. Rapid Door Pop Is used to gain rapid access to the passenger compartment and usually involves the door closest to the patient. May be performed from either the hinge side or the nadar pin side. Is also very useful on trucks and 2-door passenger cars.

29. Roof Removal Allows for the best access to the passenger compartment and is accomplished by removing all of the glass, cutting the given number of posts and removing the entire roof from the vehicle. This allows the patient to be removed without compromising their spinal alignment.

30. Roof Flap Is used when a total roof removal is not feasible or only a little room is need to free the patient. It too involves removing the glass and cutting the appropriate pillars. Even works with the care on it’s side!

31. B-Post Blow out AKA: Maxi-Door, Side wall removal. Allows for adequate access to the passenger compartment and is accomplished by removing the glass, and starting from either the hinge side or the door side. Once the 1 st door is removed the ‘B’ post is cut top and bottom and then the 2 nd door is removed. Cut Hinge Side Door side

32. Dash Roll Is used to create space in the passenger compartment. The roll provides adequate room but requires a tool be left in place, which takes up allot of valuable space. Relief cuts Capture the progress of the lift.

33. Dash Jack 1 st a relief cut in the foot well.2 nd a relief cut in the upper rail and A post. 3 rd Start spreading at the lower relief cut. Spread until you free the patient. The dash jack provides the maximum amount of passenger compartment displacement.

34. 3 rd Door Conversion Is extremely useful when extricating from a 2-door car or an extended cab truck. The 3 rd door allows for more room and better overall patient care and packaging. Finished. Material to be removed.

35. Misc. Think outside the box! Pull the steering column. Cut/Displace foot pedals. Removing Glass. Tunnel through the trunk. Perform a rear window tint. Involve the local tow companies.

36. High Strength Materials The auto industry has made huge advances in the construction of their vehicles. Although the advances are keeping passengers safer they are posing a problem for first responders. New stronger tools are not always the answer, the auto industry is still years ahead of the cutting and prying capabilities of our tools.

37. High Strength Materials Here is a clip of a brand new 2012 tool stalling while working on a 2012 Mercedes. Tools stalling on a GL320 (click to view)

38. High Strength Material Can be located through out the vehicle. The only way to tell is by peaking and pealing before you cut.

39. High Strength Materials Come in many different construction types: –Some are re-enforced with additional metal –Some are re-enforced with metal rods

40. High Strength Materials Below is a comparison between a 2012 b-pillar and a 1992 b-pillar.

41. Alternative Methods In-order to remain efficient at our craft we need to be able to overcome the obstacles by using alternative methods.

42. Alternative Methods

43. Look for clues while peaking and pealing back the trim, manufactures are starting to place stickers to assist us in where to cut and where not to cut.

44. THE END FUNNY CAR VIDEO (click to view)